Healthcare Provider Details

I. General information

NPI: 1891462685
Provider Name (Legal Business Name): ALYSHA LUNDGREN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2021
Last Update Date: 08/27/2021
Certification Date: 08/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 N AIRPORT RD
CEDAR CITY UT
84721-8401
US

IV. Provider business mailing address

1443 W 800 N STE 103
OREM UT
84057-2878
US

V. Phone/Fax

Practice location:
  • Phone: 801-655-4950
  • Fax:
Mailing address:
  • Phone: 801-655-4950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: